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You Decide Tool Kit

PC2 You Decide — A Five-Step Approach to the Personal Choice Interview, Risk Assessment, and Patient Education

PC2 You Decide is designed to guide providers in helping women choose a new contraceptive method and address concerns that their patients might have about the cardiovascular risks associated with combined hormonal contraception.

The five steps of PC2 You Decide entail:

  • Patient concerns — Focus on the woman’s agenda for her visit.

  • Choices — Find out what options are acceptable to her.

  • Personal profile — Collect and interpret facts that may influence the suitability of her preferences (lifestyle, personal factors, health history).

  • Considerations — Discuss benefits, side effects, and risks of her preferred method(s).

  • You Decide — Partner with her in making the final decision. Give her supporting information and the contact information she needs for Q & A and follow-up care.

Download a PDF example of PC2 You Decide.

The example below focuses on pregnancy prevention, combined hormonal contraception, and cardiovascular risks, but any other subject — obesity, mental health problems, etc. — could be addressed with this approach. Like SOAP notes, the PC2 You Decide approach can be used intuitively by providers to guide them through comprehensive discussions with their patients in a timely manner.

PC2 You Decide Pregnancy Prevention, Combined Hormonal Contraception (CHC), and Cardiovascular Risk
Five-Step Approach to Interviewing and Patient Education Guiding Discussion for Contraception Cardiovascular
Risk Assessment
Supporting Tools
Step 1 (subjective)
Patient concerns
Pregnancy Prevention
  • What are your pregnancy plans for the next year? The next five years?
  • How would you feel if you were to get pregnant in the next 12 months?
  • How important is it for you to prevent a pregnancy, now?
  • What would you do if you got pregnant in the next 12 months?
  Patient History Form
(Patient should complete before the patient/provider interview)
Step 2 (subjective)
Choices
Contraception
Options
  • Are you currently using a method/methods of contraception?
  • How satisfied/dissatisfied are you with this method?
  • Are you interested in a new/different method?
  • What are your needs for sexually transmitted infection (STI) protection?
  Contraceptive Efficacy Tools
Step 3 (subjective and some objective)
Personal profile
Factors that contribute to contraceptive choices and successful use (Provider reviews the
completed Self-Administered Patient History Form as a guide for the discussion.)
  • Ability to remember/keep track of schedules
  • Access to health care facility
  • Affordability
  • Age/cognitive abilities
  • Blood pressure
  • Comfort with one’s body
  • Cultural/religious influences
  • Findings of physical examination (if done)
  • Habits – smoking, ETOH (alcohol), drugs
  • Influence of others — partner(s), parents, friends
  • Medical history
  • Menstrual profile
  • Surgical history
  • Sexual behaviors
  • Weight/BMI
Warning Signs
See below.
 
Step 4 (assessment)
Considerations
Questions & Answers
  • Contraindications
  • Benefits — including non-contraceptive benefits
  • Risks
  • Side effects — what is client willing to tolerate
  • Weight gain, irregular or no bleeding
  • Evidence-based scientific information

CV Conditions Precluding Use of CHC

  • Thrombophlebitis or
    thromboembolic disorder
  • History of deep vein thrombosis or thromboembolic disorder
  • Cardiovascular or coronary artery disease
  • Valvular heart disease with thrombogenic complications
  • Uncontrolled hypertension
  • Diabetes with vascular involvement
  • Headache with focal aura
  • Major surgery with prolonged immobilization
  1. Glossary of Risk Terms
  2. Patient Comparison Risk Tools
  3. Six-Step Plan: Responding to Adverse Medical Announcement
Step 5 (plan)
You Decide
  • Contraceptive decisions
  • Instructions for contraceptive use
  • Red flags — contact your health care provider if you have CV signs/symptoms
  • Other health messages
  • Follow up
  • Periodic reassessment
Reinforce
Warning signs:
A–Abdominal Pain
C–Chest Pain
H–Headaches
E–Eye Problems
S–Severe Leg Pains
  1. Instructions for use
  2. Warning signs
  3. Other good health messages
  4. Provider contact information
  5. Follow-up appointment